Provider Demographics
NPI:1558393108
Name:ODELL, ROBIN L (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:L
Last Name:ODELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:L
Other - Last Name:RUMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 SOUTH DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3256
Mailing Address - Country:US
Mailing Address - Phone:989-773-3411
Mailing Address - Fax:989-775-3187
Practice Address - Street 1:1201 SOUTH DR
Practice Address - Street 2:SUITE 220
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3256
Practice Address - Country:US
Practice Address - Phone:989-773-3411
Practice Address - Fax:989-775-3187
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRO015128207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160C71016OtherBCBS GROUP #
MI114788614Medicaid
MIN40240006Medicare ID - Type Unspecified
MI114788614Medicaid